Yu AF, Jones LW. Breast cancer treatment-associated cardiovascular toxicity and effects of exercise countermeasures. Cardiooncology. 2016;2.In this article, the authors review what is known about anthracycline cardiotoxicity in the setting of breast cancer. A summary of trials dealing with exercise during and after treatment is then provided. Of note, Cardiooncology is a new journal dedicated to this emerging field.

 

 
Charbonnel C, Convers-Domart R, Rigaudeau S, et al. Assessment of global longitudinal strain at low-dose anthracycline-based chemotherapy, for the prediction of subsequent cardiotoxicity.Eur Heart J Cardiovasc Imaging. 2017;18(4):392-401.This study examined the optimal timing and use of echocardiographic global longitudinal strain (GLS) as a predictor of subsequent anthracycline cardiotoxicity. A total of 86 patients with lymphoma or leukemia were included and examined in 4 different time points – baseline, after a dose exceeding 150mg/m2, at the end of treatment and at one year. 6 patients developed cardiotoxicity – decrease in LVEF of >10%. A value of GLS less than -17.45 was determined as the best predictor of cardiotoxicity with a sensitivity of 67% and specificity of 97%. 

 

 
 Narayan HK, Finkelman BS, French B, et al. Detailed Echocardiographic Phenotyping in Breast Cancer Patients: Associations with Ejection Fraction Decline, Recovery, and Heart Failure Symptoms over 3 Years of Followup. Circulation:2017 Jan 19 [Epub ahead of print]This is another cohort study examining echocardiographic changes over time in breast cancer patients receiving doxorubicin and/or trastuzumab. These treatments result in modest but persistent decline in LVEF over 3 years. GLS and Volumes were significant predictors of LVEF decline.

 

 Beer LA, Kossenkov AV, Liu Q, et al. Baseline Immunoglobulin E Levels as a Marker of Doxorubicin- and Trastuzumab-Associated Cardiac Dysfunction. Circ Res. 2016;119(10):1135-1144.In addition to the identification of echocardiographic predictors of cardiotoxicity in patients receiving doxorubicin and trastuzumab, several biomarkers have been utilized. This study explored a proteomic approach comparing 3 cases of cardiotoxicity patients with 4 patients matched for age and cancer without cardiotoxicity. 862 proteins were identified in the first two pairs of cases/controls and 1360 proteins were identified in the last pair. The protein with the most significant and consistent change was immunoglobulin E. Levels of IgE were higher at baseline and follow up in patients without cardiotoxicity. In a validation study of 35 patients receiving doxorubicin and trastuzumab, higher IgE levels were protective. Therefore, in addition to the possible use of IgE levels as a clinically measurable risk factor, an immune mediated mechanism for doxorubicin/trastuzumab cardiotoxicity is implied.

 

 
Pituskin E, Mackey JR, Koshman S, et al. Multidisciplinary Approach to Novel Therapies in Cardio-Oncology Research (MANTICORE 101-Breast): A Randomized Trial for the Prevention of Trastuzumab-Associated Cardiotoxicity. J Clin Oncol. 2017;35(8):870-8.In this double-blind, placebo-controlled trial, patients with HER2-positive early breast cancer were randomly assigned to receive treatment with perindopril, bisoprolol, or placebo (1:1:1) for the duration of trastuzumab adjuvant therapy. Patients underwent cardiac magnetic resonance imaging at baseline and post-cycle 17 for the determination of left ventricular volumes and left ventricular ejection fraction (LVEF). Thirty-three patients received perindopril, 31 received bisoprolol, and 30 received placebo. In secondary analyses, trastuzumab-mediated decline in LVEF was attenuated in bisoprolol-treated patients (-1 ± 5%) relative to the perindopril (-3 ± 4%) and placebo (-5 ± 5%) groups (P=0.001). Perindopril and bisoprolol use were independent predictors of maintained LVEF on multivariable analysis.

 

 
 Stachon P, Kaier K, Milde S, et al. Two-year survival of patients screened for transcatheter aortic valve replacement with potentially malignant incidental findings in initial body computed tomography.
Eur Heart J Cardiovasc Imaging. 2015 Jul;16(7):731-7.Another topic in cardiooncology developing in recent years is the issue of cancer in aortic stenosis patients undergoing transcatheter aortic valve replacement (TAVR). These patients undergo multiple diagnostic studies prior to the procedure, including computerized tomography of the chest. These exams occasionally reveal asymptomatic malignancies. In this retrospective study, 414 patients were screened for TAVR. The incidence of malignant finfdings was impressive – 18.7%. However, the 2 year survival following TAVR or SAVR (Surgical Aortic Valve Replacement) was 75%, independent of these findings.